Division of Administration and Finance

Planning + Design + Construction

PO Box 210186
Cincinnati, Ohio 45221-0186

PROTECTIVE EQUIPMENT CHECKLIST

(Check all PPE required)

Project Number: Project Name:

Phase:

EYE & FACE FOOT

Safety glasses with side shields Hard toe shoes/boots
Chemical splash goggles Dielectric
Impact goggles Neoprene
Full face shield (worn over 1, 2, or 3 only) Rubber
Cutting goggles PVC/Urethane
Welding hood Metaltarsal guard
Other Other

HAND (GLOVES) RESPIRATORY PROTECTION

Cloth Dust mask
Leather Fume/mist mask
Welding Half face filter
Metal mesh Full face airline
Elect. Insulated Full face filter
Rubber Full face SCBA
Neoprene Emergency escape pack
Vinyl Emergency escape disposable
Butyl Other
Nitrile
Other

HEARING PROTECTIVE CLOTHING

Ear plugs Nomex/FRC
Canal caps Tyvek suits
Ear muffs Rainsuit
Dual Protection Acidsuit
Other Encapsulating suit
Other
HEAD
Class A (Limited voltage) hard hat
Class B (Hi-voltage) hard hat
Chin strap accessory
Other

List any other PPE not listed above:

DOES TASK PRESENT POTENTIAL EXPOSURE TO HAZARDOUS CHEMICALS? Yes No

If yes, has the Material Safety Data Sheet for each hazardous chemical been obtained and reviewed? Yes No

Individual Completing Checklist Date

Protective Equipment Checklist Rev 6/2002

Cc: File 0031A

Protective Equipment Checklist Rev 6/2002